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OPTUM FRONTIER THERAPIES II, LLC
RWII33511 CAN Community Health, Inc.
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Covered Entity Details
Entity Name
CAN Community Health, Inc.
Subdivision Name
Type
Ryan White Part B
340B ID
RWII33511
Entity Address
214 Morrison Road
Suite 104
Brandon, FL 33511
Grant Number
X07HA00057
Participating Start Date
10/1/2014
Last Recertification Date
2/20/2018
Entity Termination Date
1/1/2019
Pharmacy Details
Pharmacy Name
OPTUM FRONTIER THERAPIES II, LLC
Pharmacy Address
6425 SANTA MARGARITA ST UNIT 110
LAS VEGAS, NV 89118-1913
Pharmacy Comments
Contract Details
Approval Date
10/22/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2019
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Richard E. Carlisle, President & CEO
(941) 366-0134 Ext: 11111
Contract Pharmacy Representative
Optum RX
Joseph Iovino, VP
(412) 445-4495
Signed By Date
10/22/2018
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